白蛋白尿、估计肾小球滤过率与慢性肾脏病队列中心脏表型的相关性：CPH-CKD ECHO 研究。

Associations Between Albuminuria, Estimated GFR and Cardiac Phenotype in a Cohort with Chronic Kidney Disease: The CPH-CKD ECHO Study.

机构信息

Department of Cardiology, Copenhagen University Hospital, Herlev and Gentofte Hospital, Denmark; Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen.

出版信息

J Card Fail. 2022 Nov;28(11):1615-1627. doi: 10.1016/j.cardfail.2022.09.002. Epub 2022 Sep 17.

DOI:10.1016/j.cardfail.2022.09.002

PMID:36126901

Abstract

OBJECTIVE

Echocardiographic findings in chronic kidney disease (CKD) vary. We sought to estimate the prevalence of abnormal cardiac structure and function in patients with CKD and their association to estimated glomerular filtration rate (eGFR) and urine albumin/creatinine ratio (UACR).

METHODS

We prospectively enrolled 825 outpatients with non-dialysis-dependent CKD, mean age 58± 13 yrs, and 175 matched healthy controls, mean age 60±12 yrs. Echocardiography included assessment of left ventricular (LV) hypertrophy, LV ejection fraction (LVEF), global longitudinal strain (GLS) and diastolic dysfunction according to ASE/EACVI guidelines.

RESULTS

LV hypertrophy was found in 9% of patients vs. 1.7% of controls (p=0.005) was independently associated with UACR (p=0.002). Median LVEF was 59.4% (IQR 55.2, 62.8) in patients vs. 60.8% (57.7, 64.1) in controls (p=0.002). GLS was decreased in patients with eGFR <60ml/min/1.73m² (-17.6%±3.1%) vs. patients with higher eGFR (19.0%±2.2%, p<0.001), who were similar to controls. Diastolic dysfunction was detected in 55% of patients and in 34% of controls.

LIMITATIONS

Non-random sampling, cross-sectional analysis.

CONCLUSIONS

We report lower prevalence of hypertrophy than previous studies, but similar measurements of systolic and diastolic function. Cardiac remodeling in CKD may be influenced by treatment modalities, demographics, comorbidities and renal pathology.

摘要

目的

慢性肾脏病（CKD）的超声心动图表现各异。我们旨在评估 CKD 患者异常心脏结构和功能的发生率，并分析其与估算肾小球滤过率（eGFR）和尿白蛋白/肌酐比值（UACR）的相关性。

方法

我们前瞻性纳入了 825 例非透析依赖性 CKD 门诊患者，平均年龄 58±13 岁，以及 175 例匹配的健康对照者，平均年龄 60±12 岁。超声心动图包括根据 ASE/EACVI 指南评估左心室（LV）肥厚、LV 射血分数（LVEF）、整体纵向应变（GLS）和舒张功能障碍。

结果

LV 肥厚在患者中占 9%，而在对照者中占 1.7%（p=0.005），且与 UACR 独立相关（p=0.002）。患者的中位 LVEF 为 59.4%（IQR 55.2，62.8），而对照者为 60.8%（57.7，64.1）（p=0.002）。eGFR<60ml/min/1.73m² 的患者 GLS 降低（-17.6%±3.1%），而 eGFR 较高的患者（19.0%±2.2%）与对照者相似（p<0.001）。55%的患者和 34%的对照者存在舒张功能障碍。